Accelerated orthodontics

An intersection of two worlds. AcceleDent’s science and technology are nothing new. The AcceleDent is essentially addressing an old problem (how can teeth be moved faster) with an old technology (vibrating bone to speed up its biology) – but in a completely new and high-tech way.

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AcceleDent’s technology is predicated on the application of pulsating, low magnitude forces (cyclic forces) to the teeth and surrounding bone as a means of accelerated orthodontics tooth movement. It is important to understand the history of this science and technology. Many different approaches to accelerated orthodontics have been employed in the past. And given all of the disadvantages associated with wearing braces for a lengthy duration, this fact is not a huge surprise. Some attempts at accelerated orthodontics have been more creative than others. Irradiation with lasers has been used, as well as pharmacological approaches have been employed.

But they have all come along with different sets of problems, such as pain, severe root resorption, and drug-induced side effects. One invention back in the 1970’s even involved powered brackets … each with a tiny working motor. For obvious reasons, these “braces” were never marketed. The quest for accelerated orthodontics continued and eventually came to include Dr. Jeremy Mao’s work (Chairman, OrthoAccel Scientific Advisory Board). The big step taken here was that vibratory forces could actually complement the existing orthodontics. An initial design based on preliminary work involved placing the motor inside the mouth. And through the years, various other ultrasonic (very high frequency vibration) and magnetic approaches have been attempted … none with any degree of success.

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One of the biggest breakthroughs in accelerated orthodontics has come with the resurgence of self-ligating brackets. Although the first self-ligating fixed appliances were invented over thirty years ago, this category of innovation has really only become “mainstream” in the last five – ten years. Through reducing friction at the bracket-archwire interface, self-ligation certainly achieves accelerated orthodontics through more efficient biomechanics. These appliances, however, do nothing to speed up the physiological rate of tooth movement. Probably the most interesting (and dramatically successful) approach has come with the recent emergence of surgical-based accelerated orthodontics.

Interestingly, surgically-assisted orthodontic tooth movement has been used since the 1800’s. In the past 50 years, there have been infrequent reports of its successful use as a procedure for shortening orthodontic treatment duration. More recently, in the early 2000’s, Drs. Thomas and William Wilcko modified the traditional corticotomy-assisted technique with the addition of alveolar augmentation. In fact, this procedure was even patented and branded as “Wilckodontics.” The results have been remarkable … treatment times have typically been reduced one-third to one-fourth that of traditional treatment. It does however necessitate a very invasive surgical procedure and therefore the involvement of an oral surgeon or periodontist.

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More recently, work out of Dr. Jeremy Mao’s laboratory (Chairman, OrthoAccel® Scientific Advisory Board) demonstrated accelerated bone remodeling in the growth of craniofacial structures in a variety of animal models. This research was groundbreaking, because it was an application in the craniofacial region, or in other words … above the neck. There are many important differences between the craniofacial skeleton and the appendicular skeleton, for example, they are derived from different embryological origins. Dr. Mao’s work then was the first to suggest that an orthodontic tooth movement application could be feasible. In early 2008, a confirmatory paper was published in the American Journal of Orthodontics and Dentofacial Orthopaedics out of Tohoku University, Sendai, Japan using a rodent model. The results were clear: the treatment group received cyclic forces once per week for just eight minutes, and showed significantly accelerated tooth movement when compared to the control group.

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It is believed that cyclic forces increase the cellular signaling that regulates bone remodeling, thus enhancing the rate of orthodontic tooth movement. Moving teeth with braces requires external forces (applied by the Invisalign aligners) to be converted to cellular signals or factors that result in coordinated bone remodeling. Factors that increase the rate of bone remodeling have been shown to increase the rate of tooth movement. In a number of studies it has been shown that prostaglandins are involved in the bone removal component of orthodontic tooth movement. In addition, inhibitors to prostaglandin production, (cyclooxygenase, or COX, inhibitors) are known to decrease the amount of orthodontic tooth movement. Similarly, it has been shown that administration of certain prostaglandins locally caused an increase in orthodontic bone resorption and tooth movement. Parathyroid hormone (PTH) is a potent bone-remodeling factor. Continuous infusion of PTH has been shown to cause a 2 fold increase in the rate of orthodontic tooth movement in rats. The hypothesis, then, is that the pulsating force up-regulates and down-regulates certain cellular signaling pathways, resulting in faster tooth movement. Dental researchers have long postulated that a pulsating force might also be used to successfully move teeth and alleviate the discomfort associated with traditional orthodontics. A number of different devices have been marketed in the past which use various means of vibrating the teeth, although none were designed with the clinical benefit of faster tooth movement in mind … periodontal disease and treatment through increased blood flow to the gums has been a popular indication. Typically, these products employed such cumbersome designs as external power sources, fluid-based mechanics, and even a radio and speaker set to generate vibration! And all were mounted on extraoral headgear and face bow designs.